Newborn clavicle fractures: 5 year-review of a tertiary-care hospital.

Objectives: Clavicle fractures are the most common birth-related fractures. They may cause pain, arm mobility impairment, and brachial nerve injury (temporary or definitive). Therefore, we aimed to review the incidence, risk factors and prognosis of neonatal clavicle fractures in our hospital. Methods: All cases of clavicle fractures diagnosed and registered during the neonatal period between 2018 and 2022, in a tertiary-care Portuguese hospital, were reviewed. Statistical descriptive analysis, odds ratios (ORs), and 95% confidence intervals(95%CI) were calculated. Results: A total of 8132 births and 91 clavicle fractures were identified (1.1% incidence) - 0.04% (1/2512) in cesarean sections and 1.7% (90/5453) in vaginal births. An instrumental vaginal birth doubled the probability of clavicle fractures (OR 2.072, 95%CI 1.365-3.145 compared to spontaneous births). In 15.4% of clavicle fractures, births were complicated by shoulder dystocia. Shoulder dystocia significantly increased the risk of clavicle fracture (OR 35.71; 95% CI 17.86-71.43). Of the 91 cases, 22% resulted from pregnancies complicated by gestational diabetes; in these cases, the risk of clavicle fractures increased 76% (OR 1.761, 95%CI 1.068-2.904). Most of the cases were referred to a Neonatology follow-up appointment (92.3%). Fifteen neonates had a clinical suspicion of brachial plexus injury, but all of them regained normal arm mobility after physiotherapy. Conclusion: The incidence of clavicle fractures in our hospital is comparable to the literature (1.1%). To reduce the incidence of clavicle fractures not only its risk factors must be reduced, but a simulation-based labor ward team training program on shoulder dystocia should also be implemented.